Alessandra Manerba

Publications (13)45.42 Total impact

• Article: [Chronic heart failure therapy: where we are and where we are going to].

  Savina Nodari, Marco Triggiani, Alessandra Manerba, Laura Lupi, Livio Dei Cas
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  ABSTRACT: Despite significant advances in pharmacological and non-pharmacological therapy, epidemiological data from European and US hospitals show that the prevalence of heart failure (HF) hospitalization, especially for patients >65 years, continues to rise. Hospitalization for worsening HF is one of the most important predictors of short- and long-term outcomes in patients with chronic HF. There is therefore a clear need for new therapies that can work synergistically with standard medications to reverse the progression of the disease and improve myocardial efficiency. In the last years, researches in chronic HF focused on drugs that can exert a greater attenuation of neurohormonal activation and that can improve cardiac energy and substrate utilization.
  Giornale italiano di cardiologia (2006) 10/2012; 13(10):145-51.
• Article: Response to the Letter of Hester Den Ruijter and Ruben Coronel Regarding the Article “The Role of n-3 PUFAs in Preventing the Arrhythmic Risk in Patients with Idiopathic Dilated Cardiomyopathy”

  Savina Nodari, Marco Metra, Giuseppe Milesi, Alessandra Manerba, Bruno Mario Cesana, Mihai Gheorghiade, Livio Dei Cas
  Cardiovascular Drugs and Therapy 04/2012; 23(4):335-336. · 3.13 Impact Factor
• Article: Effects of supplementation with polyunsaturated fatty acids in patients with heart failure.

  Savina Nodari, Marco Triggiani, Alessandra Manerba, Giuseppe Milesi, Livio Dei Cas
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  ABSTRACT: Despite the clinical and prognostic improvement obtained with the current medical treatment, heart failure (HF) continues to have high morbidity and mortality and its prevalence is increasing in most regions of the world. Thus, there is a need for novel adjunctive therapies that act independently of current neurohormonally and haemodynamically oriented drugs. Nutritional approaches are particularly attractive because they could work additively with established therapies without negative hemodynamic effects. There is growing evidence that omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation positively impacts established pathophysiological mechanisms in HF and thus has a potential role for preventing and treating HF. The results of the GISSI-HF trial have indicated that, in patients with chronic HF on evidence-based therapy, long term treatment with PUFAs reduced mortality and hospitalizations for cardiovascular reasons, irrespective of etiology and left ventricular (LV) ejection fraction (EF). The purpose of this review is to summarize the evidence emerged from studies conducted so far on the effect of n-3 PUFAs in HF.
  Internal and Emergency Medicine 10/2011; 6 Suppl 1:37-44. · 2.06 Impact Factor
• Article: Six-year prognosis of diabetic patients with coronary artery disease.

  Savina Nodari, Alessandra Manerba, Alberto Vaccari, Giuseppe Milesi, Valentina Carubelli, Valentina Lazzarini, Carlo Lombardi, Federica Ettori, Marco Metra, Alessandra Dei Cas
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  ABSTRACT: Diabetes is associated with increased cardiovascular mortality. The aim of our study was to determine the prognostic factors for mortality in patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) who underwent coronary angiography and percutaneous coronary intervention. Four hundred and forty-five consecutive T2DM patients with significant CAD (≥ 75% stenosis) were included in our analysis. All patients underwent standard clinical examination, laboratory tests and transthoracic echocardiography with measurement of the left ventricular ejection fraction. Severity of CAD at the coronary angiography was evaluated using the Gensini score. Clinical follow-up was completed at 1, 3 and 6 years. During a mean follow-up of 73·3 ± 22·1 months, 109 patients died (24·5%). Significant determinants of an increased risk of death at multivariable analysis were age (p < 0·001), serum creatinine (p = 0·001), peripheral vascular disease (p = 0·002), serum glucose (p = 0·004), serum fibrinogen (p = 0·011) and history of heart failure (HF, p = 0·011). When all the variables were entered as categorical variables, with continuous variables split at their median value, only history of HF, estimated glomerular filtration rate, serum glucose, serum fibrinogen (all p < 0·0001) and beta-blocker therapy at discharge (p = 0·027) were selected. Our study shows a relatively good prognosis of patients with T2DM. Comorbidities, namely HF and renal impairment, are main determinants of survival.
  European Journal of Clinical Investigation 09/2011; 42(4):376-83. · 3.02 Impact Factor
• Article: n-3 polyunsaturated fatty acids in the prevention of atrial fibrillation recurrences after electrical cardioversion: a prospective, randomized study.

  Savina Nodari, Marco Triggiani, Umberto Campia, Alessandra Manerba, Giuseppe Milesi, Bruno M Cesana, Mihai Gheorghiade, Livio Dei Cas
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  ABSTRACT: n-3 polyunsaturated fatty acids (n-3 PUFAs) exert antiarrhythmic effects and reduce sudden cardiac death. However, their role in the prevention of atrial fibrillation remains controversial. We aimed to determine the effect of n-3 PUFAs in addition to amiodarone and a renin-angiotensin-aldosterone system inhibitor on the maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation. We conducted a randomized, double-blind, placebo-controlled, parallel-arm trial in patients with persistent atrial fibrillation, with at least 1 relapse after cardioversion, and treated with amiodarone and a renin-angiotensin-aldosterone system inhibitor. Participants were assigned to placebo or n-3 PUFAs 2 g/d and then underwent direct current cardioversion 4 weeks later. The primary end point was the probability of maintenance of sinus rhythm at 1 year after cardioversion. Of 254 screened patients, 199 were found to be eligible and randomized. At the 1-year follow up, the probability of maintenance of sinus rhythm was significantly higher in the n-3 PUFAs-treated patients compared with the placebo group (hazard ratio, 0.62 [95% confidence interval, 0.52 to 0.72] and 0.36 [95% confidence interval, 0.26 to 0.46], respectively; P=0.0001). In patients with persistent atrial fibrillation on amiodarone and a renin-angiotensin-aldosterone system inhibitor, the addition of n-3 PUFAs 2 g/d improves the probability of the maintenance of sinus rhythm after direct current cardioversion. Our data suggest that n-3 PUFAs may exert beneficial effects in the prevention of atrial fibrillation recurrence. Further studies are needed to confirm and expand our findings. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01198275.
  Circulation 08/2011; 124(10):1100-6. · 14.74 Impact Factor
• Article: Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy.

  Savina Nodari, Marco Triggiani, Umberto Campia, Alessandra Manerba, Giuseppe Milesi, Bruno M Cesana, Mihai Gheorghiade, Livio Dei Cas
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  ABSTRACT: This study was designed to test the effects of n-3 polyunsaturated fatty acids (PUFAs) on left ventricular (LV) systolic function in chronic heart failure (HF) due to nonischemic dilated cardiomyopathy (NICM). One hundred thirty-three patients with NICM and minimal symptoms on standard therapy were randomized to 2 g of n-3 PUFAs or placebo. LV function and functional capacity were assessed prospectively by echocardiography and cardiopulmonary exercise testing at baseline and at 12 months after randomization. Patients with chronic HF due to NICM and minimal symptoms while receiving evidence-based therapy were enrolled. LV function and functional capacity were assessed prospectively by echocardiography, cardiopulmonary exercise test, and New York Heart Association functional class at baseline and at 12 months after randomization to either 2 g of n-3 PUFAs or placebo. At 12 months after randomization, the n-3 PUFAs group and the placebo group differed significantly (p <0.001) in regard to: 1) LV ejection fraction (increased by 10.4% and decreased by 5.0%, respectively); 2) peak VO(2) (increased by 6.2% and decreased by 4.5%, respectively); 3) exercise duration (increased by 7.5% and decreased by 4.8%, respectively); and 4) mean New York Heart Association functional class (decreased from 1.88 ± 0.33 to 1.61 ± 0.49 and increased from 1.83 ± 0.38 to 2.14 ± 0.65, respectively). The hospitalization rates for HF were 6% in the n-3 PUFAs and 30% in the placebo group (p = 0.0002). In patients with NICM and minimal symptoms in response to evidence-based medical therapy, n-3 PUFAs treatment increases LV systolic function and functional capacity and may reduce hospitalizations for HF. Given these promising results, larger studies are in order to confirm our findings.
  Journal of the American College of Cardiology 02/2011; 57(7):870-9. · 14.16 Impact Factor
• Article: n-3 PUFAs and cardiovascular disease prevention.

  Alessandra Manerba, Enrico Vizzardi, Marco Metra, Livio Dei Cas
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  ABSTRACT: Today, there are several observational and experimental studies, especially clinical randomized trials, that have proven the beneficial effects of n-3 polyunsaturated fatty acids (PUFAs). The most compelling evidence for the cardiovascular benefits of n-3 PUFAs comes from studies of primary prevention in patients following myocardial infarction, and most recently, in patients with heart failure. In this review, we analyze the evidence from epidemiologic studies and from large randomized controlled trials showing the benefits of n-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in primary and secondary cardiovascular prevention. Further studies are needed to determine optimal dosing and the relative ratio of DHA and EPA that provide maximal cardioprotection.
  Future Cardiology 05/2010; 6(3):343-50.
• Article: Response to the Letter of Hester Den Ruijter and Ruben Coronel Regarding the Article "The Role of n-3 PUFAs in Preventing the Arrhythmic Risk in Patients with Idiopathic Dilated Cardiomyopathy"

  Savina Nodari, Marco Metra, Giuseppe Milesi, Alessandra Manerba, Bruno Cesana, Mihai Gheorghiade, Livio Dei Cas
  Cardiovascular Drugs and Therapy 06/2009; · 3.13 Impact Factor
• Article: High sensitivity C-reactive protein: a predictor for recurrence of atrial fibrillation after successful cardioversion.

  Enrico Vizzardi, Savina Nodari, Gregoriana Zanini, Alessandra Manerba, Silvia Frattini, Alberto Madureri, Riccardo Raddino, Livio Dei Cas
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  ABSTRACT: Atrial fibrillation (AF) is often associated, more or less indirectly, with an inflammatory acute or chronic process. So it is probable that the inflammation could contribute to the genesis and the perpetuation of this dysrhythmia. Phlogistic test indexes in patients (pts) with AF will be positive and have prognostic significance in patients treated with electrical cardioversion with restoration of a sinus rhythm. We evaluated 106 pts affected by AF of recent onset without known cardiovascular disease. We measured the plasma concentration of C-reactive protein (CRP) through a high sensibility method, in addition to routine blood samples. We performed an ECG 1 week and a Holter ECG monitoring 1 and 6 months after the electrical cardioversion. The CRP values were high (5.8 +/- 10.7 U/L), with values above the normal range in 60 pts. After electrical cardioversion, we obtained restoration of sinus rhythm in all the patients. One week after cardioversion, 85 pts (80%) were in sinus rhythm, while after 6 months 60 pts (56%) maintained a sinus rhythm. In total 46 (43%) patients had a recurrence of atrial fibrillation within 6 months, and 41 of these 46 patients (89%) had elevated values of CRP (P < 0.001 with respect to the patients who maintained a sinus rhythm). 18/21 patients (86%) with an AF relapse in the first week and 23/25 patients (92%) with AF recurrences at 6 months later had elevated values of CRP. The patients with AF may have elevated values of CRP, and the assessment of this increase may be predictive of early relapses of AF after electrical cardioversion.
  Internal and Emergency Medicine 04/2009; 4(4):309-13. · 2.06 Impact Factor
• Article: The role of n-3 PUFAs in preventing the arrhythmic risk in patients with idiopathic dilated cardiomyopathy.

  Savina Nodari, Marco Metra, Giuseppe Milesi, Alessandra Manerba, Bruno Mario Cesana, Mihai Gheorghiade, Livio Dei Cas
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  ABSTRACT: N-3 polyunsaturated fatty acids (n-3 PUFAs) intake is associated with a reduction in sudden cardiac death in patients with ischemic heart disease. Their effects in patients with heart failure caused by idiopathic dilated cardiomyopathy (IDC) are unknown. We compared with placebo the effects of n-3 PUFAs administration in 44 patients with IDC and with frequent or repetitive ventricular arrhythmias at Holter monitoring using a randomized, double-blind design. Arrhythmic risk was assessed by microvolt T-wave analysis (MTWA), signal averaged ECG (SAECG), Holter monitoring, power spectral analysis of heart rate (HR) variability, catecholamine and cytokine plasma levels, at baseline and after 6 months. At MTWA, 7/12 patients (58%) initially positive became negative after n-3 PUFAs while one patient became positive after placebo (p = 0.019). N-3 PUFAs administration was also associated to normalization of SAECG (11/15 patients, p < 0.0015), decrease in non-sustained ventricular tachycardia (NSVT) episodes (p = 0.0002) and NSVT HR (p = 0.0003), improvement in HR variability and decrease in catecholamine and cytokine plasma levels. The ratio of plasma n-6 PUFAs to n-3 PUFAs decreased from 12.01 to 3.48 after n-3 PUFAs. N-3 PUFAs administration is associated with favorable effects on parameters related to arrhythmic risk in patients with idiopathic dilated cardiomyopathy. These results are consistent with antiarrhythmic activity independent from their antiischemic effects.
  Cardiovascular Drugs and Therapy 11/2008; 23(1):5-15. · 3.13 Impact Factor
• Source

  Available from: PubMed Central

  Article: Endocannabinoids and cardiovascular prevention: real progress?

  Savina Nodari, Alessandra Manerba, Marco Metra, Livio Dei Cas
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  ABSTRACT: The prevalence of obesity continues to increase and represents one of the principal causes of cardiovascular morbidity and mortality. After the discovery of a specific receptor of the psychoactive principle of marijuana, the cannabinoid receptors and their endogenous ligands, several studies have demonstrated the role of this system in the control of food intake and energy balance and its overactivity in obesity. Recent studies with the CB1 receptor antagonist rimonabant have demonstrated favorable effects such as a reduction in body weight and waist circumference and an improvement in metabolic factors (cholesterol, triglycerides, glycemia etc). Therefore, the antagonism of the endocannabinoid (EC) system, if recent data can be confirmed, could be a new treatment target for high risk overweight or obese patients. Obesity is a growing problem that has epidemic proportions worldwide and is associated with an increased risk of premature death (1-3). Individuals with a central deposition of fats have elevated cardiovascular morbidity and mortality (including stroke, heart failure and myocardial infarction) and, because of a growing prevalence not only in adults but also in adolescents, it was reclassified in AHA guidelines as a "major modifiable risk factor" for coronary heart disease (4, 5). Although first choice therapy in obesity is based on correcting lifestyle (diet and physical activity) in patients with abdominal obesity and high cardiovascular risk and diabetes, often it is necessary to use drugs which reduce the risks. The EC system represents a new target for weight control and the improvement of lipid and glycemic metabolism (6, 7).
  Heart International 01/2007; 3(1):27.
• Chapter: The Prevention of Sudden Death: New Perspectives

  Savina Nodari, Marco Metra, Alessandra Manerba, Silvia Frattini, Giuseppe Seresini, Livio dei Cas
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  ABSTRACT: Sudden cardiac death (SCD) is unexpected natural death due to cardiac causes, and includes the abrupt loss of consciousness within 1 h from the onset of acute symptoms, with or without preexisting heart disease. It is very difficult to evaluate the exact incidence of SCD because the concept of “sudden events” has not been precisely defined [1].
  12/2006: pages 205-213;
• Article: [Plasma brain natriuretic peptide levels in the diagnostic and prognostic assessment of patients with heart failure. Pros].

  Marco Metra, Savina Nodari, Claudio Pedrinazzi, Patrizia Rocca, Alessandra Manerba, Enrico Vizzardi, Rossella Danesi, Livio Dei Cas
  Italian heart journal: official journal of the Italian Federation of Cardiology 01/2004; 4 Suppl 8:59S-67S.